Brachytherapy or surgery? A composite view.

The treatment of prostate cancer presents the patient and clinician with several options. The choice of modality is often the most difficult. For low- and intermediate-risk disease, the choice is often between surgery and brachytherapy because the other major option, external-beam radiotherapy, has toxicity that generally only makes sense in the risk/benefit analysis for high-risk prostate cancer. The comparison of brachytherapy and surgery may be done on several levels. This review will focus the comparison on toxicity, the "soft" endpoints of biochemical relapse-free survival and clinical relapse-free survival, and the "hard" endpoint of prostate cancer-specific mortality.